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Murakami W, Mortazavi S, Yu T, Kathuria-Prakash N, Yan R, Fischer C, McCann KE, Lee-Felker S, Sung K. Clinical Significance of Background Parenchymal Enhancement in Breast Cancer Risk Stratification. J Magn Reson Imaging 2024; 59:1742-1757. [PMID: 37724902 DOI: 10.1002/jmri.29015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Background parenchymal enhancement (BPE) is an established breast cancer risk factor. However, the relationship between BPE levels and breast cancer risk stratification remains unclear. PURPOSE To evaluate the clinical relationship between BPE levels and breast cancer risk with covariate adjustments for age, ethnicity, and hormonal status. STUDY TYPE Retrospective. POPULATION 954 screening breast MRI datasets representing 721 women divided into four cohorts: women with pathogenic germline breast cancer (BRCA) mutations (Group 1, N = 211), women with non-BRCA germline mutations (Group 2, N = 60), women without high-risk germline mutations but with a lifetime breast cancer risk of ≥20% using the Tyrer-Cuzick model (Group 3, N = 362), and women with <20% lifetime risk (Group 4, N = 88). FIELD STRENGTH/SEQUENCE 3 T/axial non-fat-saturated T1, short tau inversion recovery, fat-saturated pre-contrast, and post-contrast T1-weighted images. ASSESSMENT Data on age, body mass index, ethnicity, menopausal status, genetic predisposition, and hormonal therapy use were collected. BPE levels were evaluated by two breast fellowship-trained radiologists independently in accordance with BI-RADS, with a third breast fellowship-trained radiologist resolving any discordance. STATISTICAL TESTS Propensity score matching (PSM) was utilized to adjust covariates, including age, ethnicity, menopausal status, hormonal treatments, and prior bilateral oophorectomy. The Mann-Whitney U test, chi-squared test, and univariate and multiple logistic regression analysis were performed, with an odds ratio (OR) and corresponding 95% confidence interval. Weighted Kappa statistic was used to assess inter-reader variation. A P value <0.05 indicated a significant result. RESULTS In the assessment of BPE, there was substantial agreement between the two interpreting radiologists (κ = 0.74). Patient demographics were not significantly different between patient groups after PSM. The BPE of Group 1 was significantly lower than that of Group 4 and Group 3 among premenopausal women. In estimating the BPE level, the OR of gene mutations was 0.35. DATA CONCLUSION Adjusting for potential confounders, the BPE level of premenopausal women with BRCA mutations was significantly lower than that of non-high-risk women. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Wakana Murakami
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
- Department of Radiology, Showa University, School of Medicine, Tokyo, Japan
| | - Shabnam Mortazavi
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Tiffany Yu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Nikhita Kathuria-Prakash
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Ran Yan
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
- Department of Bioengineering, University of California at Los Angeles, Los Angeles, California, USA
| | - Cheryce Fischer
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Kelly E McCann
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Stephanie Lee-Felker
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Kyunghyun Sung
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
- Department of Bioengineering, University of California at Los Angeles, Los Angeles, California, USA
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Baclig NV, McCann KE. Updates in the treatment of HR+HER2- breast cancer. Curr Opin Obstet Gynecol 2024; 36:57-63. [PMID: 38170552 DOI: 10.1097/gco.0000000000000925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Breast cancer (BC) is the most common cancer among women in the United States and the second leading cause of cancer death. BC research, diagnostics, drug development, and expansion of therapies for novel indications advances so rapidly that BC treatment standards change month-by-month. Herein we discuss notable advancements in the past year for hormone receptor positive (HR+) HER2 negative (HER2-) BC. RECENT FINDINGS Radiolabeled estradiol imaging and circulating tumor DNA (ctDNA) have changed our approach to metastatic BC (mBC) detection. Amongst an abundance of therapy options, treatment de-escalation to avoid toxicities is a priority. Promising results with CDK4/6 inhibitors in the curative setting have been demonstrated even as we await final data for use in the metastatic setting. Several novel endocrine therapies are expected to gain FDA-approval in the near future. Antibody-drug conjugates have expanded from other mBC types to HR+HER2- mBC. The PROMISE trial helped define disease recurrence outcomes for premenopausal women seeking pregnancy. SUMMARY The diagnostic and treatment landscape for HR+HER2- BC continues to rapidly evolve on multiple fronts.
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Affiliation(s)
- Nikita V Baclig
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
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McCann KE, Goldfarb SB, Traina TA, Regan MM, Vidula N, Kaklamani V. Selection of appropriate biomarkers to monitor effectiveness of ovarian function suppression in pre-menopausal patients with ER+ breast cancer. NPJ Breast Cancer 2024; 10:8. [PMID: 38242892 PMCID: PMC10798954 DOI: 10.1038/s41523-024-00614-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/03/2024] [Indexed: 01/21/2024] Open
Abstract
Use of gonadotropin-releasing hormone (GnRH) agonists has been widely adopted to provide reversible ovarian function suppression for pre-menopausal breast cancer patients who are also receiving aromatase inhibitor or tamoxifen therapy based on results of 25 randomized trials representing almost 15,000 women demonstrating a survival benefit with this approach. Past clinical trials designed to establish the efficacy of GnRH agonists have monitored testosterone in the prostate cancer setting and estradiol in the breast cancer setting. We explore the merits of various biomarkers including estradiol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) and their utility for informing GnRH agonist treatment decisions in breast cancer. Estradiol remains our biomarker of choice in ensuring adequate ovarian function suppression with GnRH agonist therapy among pre-menopausal women with breast cancer. We recommend future trials to continue to focus on estradiol levels as the primary endpoint, as they have in the past.
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Affiliation(s)
- Kelly E McCann
- University of California Los Angeles Medical Center, Los Angeles, CA, 90095, USA
| | - Shari B Goldfarb
- Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Tiffany A Traina
- Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Meredith M Regan
- Dana Farber Cancer Institute / Harvard Medical School, Boston, MA, 02215, USA
| | | | - Virginia Kaklamani
- University of Texas Health Sciences Center San Antonio / MD Anderson Cancer Center, San Antonio, TX, 78229, USA.
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McCann KE, Oestreicher N, Rowan CG, Vidal GA. CLO23-051: Real-World Use of Neratinib in Patients With HER2-Positive Early-Stage Breast Cancer Following Prior Ado-Trastuzumab Emtansine (T-DM1) or Dual HER2 Blockade With Pertuzumab Plus Trastuzumab. J Natl Compr Canc Netw 2023. [DOI: 10.6004/jnccn.2022.7177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Wainberg ZA, Singh AS, Konecny GE, McCann KE, Hecht JR, Goldman J, Chmielowski B, Finn RS, O'Brien N, Von Euw E, Price MM, Martinez D, Yonemoto L, Brennan M, Glaspy JA, Slamon DJ. Preclinical and Clinical Trial Results Using Talazoparib and Low-Dose Chemotherapy. Clin Cancer Res 2023; 29:40-49. [PMID: 36136304 DOI: 10.1158/1078-0432.ccr-22-1553] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/25/2022] [Accepted: 09/19/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE On the basis of preclinical data, we hypothesized that low doses of chemotherapy (10% of therapeutic doses) with full dose of a PARP inhibitor could have improved efficacy and tolerability. PATIENTS AND METHODS In this phase I dose-escalation study, patients with BRCA-normal advanced malignancies were assigned to either talazoparib/temozolomide or talazoparib/irinotecan. Talazoparib was dose-escalated from 500 mcg to 1 mg daily before dose escalation of temozolomide/irinotecan. The starting dose of temozolomide was 25 mg/m2/day orally on days 1 to 5 and irinotecan was 25 mg/m2/day intravenously on days 1 and 15. The primary objectives of this trial were safety and tolerability, dose-limiting toxicities (DLT), and maximum tolerated dose (MTD). RESULTS Of 40 patients enrolled, 18 (mean: 7 prior therapies) were enrolled in talazoparib + temozolomide and 22 in talazoparib + irinotecan. DLTs were hematologic in both arms, but all hematologic adverse events resolved with either treatment interruption and/or dose reductions of talazoparib. The MTDs were talazoparib 1 mg + temozolomide 37.5 mg/m2 and talazoparib 1 mg + irinotecan 37.5 mg/m2. There were four partial responses in the talazoparib + temozolomide arm and five in the talazoparib + irinotecan arm for a response rate of 23% (9/40). The pharmacokinetic profiles of talazoparib + temozolomide/irinotecan were similar to that of talazoparib monotherapy. Responses were seen independent of homologous recombination (HR) status and HR deficiency score. CONCLUSIONS These results show that talazoparib with low-dose temozolomide or irinotecan is reasonably well tolerated and demonstrates clinical activity in a wide range of cancers. Randomized trials of talazoparib with or without low-dose chemotherapy are ongoing in small cell lung cancer and ovarian cancer.
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Affiliation(s)
- Zev A Wainberg
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Arun S Singh
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Gottfried E Konecny
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Kelly E McCann
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - J Randolph Hecht
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Jonathan Goldman
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Bartosz Chmielowski
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Richard S Finn
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Neil O'Brien
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Erika Von Euw
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Megan M Price
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Diego Martinez
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Lisa Yonemoto
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Meghan Brennan
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - John A Glaspy
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Dennis J Slamon
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
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Murakami W, Won Choi H, Joines MM, Hoyt A, Doepke L, McCann KE, Salamon N, Sayre J, Lee-Felker S. Quantitative Predictors of Response to Neoadjuvant Chemotherapy on Dynamic Contrast-enhanced 3T Breast MRI. J Breast Imaging 2022; 4:168-176. [PMID: 38422427 DOI: 10.1093/jbi/wbab095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To assess whether changes in quantitative parameters on breast MRI better predict pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) in breast cancer than change in volume. METHODS This IRB-approved retrospective study included women with newly diagnosed breast cancer who underwent 3T MRI before and during NAC from January 2013 to December 2019 and underwent surgery at our institution. Clinical data such as age, histologic diagnosis and grade, biomarker status, clinical stage, maximum index cancer dimension and volume, and surgical pathology (presence or absence of in-breast pCR) were collected. Quantitative parameters were calculated using software. Correlations between clinical features and MRI quantitative measures in pCR and non-pCR groups were assessed using univariate and multivariate logistic regression. RESULTS A total of 182 women with a mean age of 52 years (range, 26-79 years) and 187 cancers were included. Approximately 45% (85/182) of women had pCR at surgery. Stepwise multivariate regression analysis showed statistical significance for changes in quantitative parameters (increase in time to peak and decreases in peak enhancement, wash out, and Kep [efflux rate constant]) for predicting pCR. These variables in combination predicted pCR with 81.2% accuracy and an area under the curve (AUC) of 0.878. The AUCs of change in index cancer volume and maximum dimension were 0.767 and 0.613, respectively. CONCLUSION Absolute changes in quantitative MRI parameters between pre-NAC MRI and intra-NAC MRI could help predict pCR with excellent accuracy, which was greater than changes in index cancer volume and maximum dimension.
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Affiliation(s)
- Wakana Murakami
- University of California at Los Angeles David Geffen School of Medicine, Department of Radiological Sciences, Los Angeles, CA, USA
- Showa University Graduate School of Medicine, Department of Radiology, Shinagawa-ku, Tokyo, Japan
| | - Hyung Won Choi
- University of California at Los Angeles David Geffen School of Medicine, Department of Radiological Sciences, Los Angeles, CA, USA
| | - Melissa M Joines
- University of California at Los Angeles David Geffen School of Medicine, Department of Radiological Sciences, Los Angeles, CA, USA
| | - Anne Hoyt
- University of California at Los Angeles David Geffen School of Medicine, Department of Radiological Sciences, Los Angeles, CA, USA
| | - Laura Doepke
- University of California at Los Angeles David Geffen School of Medicine, Department of Radiological Sciences, Los Angeles, CA, USA
| | - Kelly E McCann
- University of California at Los Angeles David Geffen School of Medicine, Department of Medicine, Los Angeles, CA, USA
| | - Noriko Salamon
- University of California at Los Angeles David Geffen School of Medicine, Department of Radiological Sciences, Los Angeles, CA, USA
| | - James Sayre
- University of California at Los Angeles Fielding School of Public Health, Department of Biostatistics, Los Angeles, CA, USA
| | - Stephanie Lee-Felker
- University of California at Los Angeles David Geffen School of Medicine, Department of Radiological Sciences, Los Angeles, CA, USA
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Abstract
PURPOSE OF REVIEW Triple negative breast cancer (TNBC) is defined by a lack of targets, namely hormone receptor (HR) expression and human epidermal growth factor receptor 2 amplification. Cytotoxic chemotherapy remains the mainstay of treatment. Though TNBC constitutes approximately 10-15% of breast cancer, it is disproportionally lethal, but it is hoped that outcomes will improve as targetable oncogenic drivers are identified. RECENT FINDINGS Translational work in TNBC has focused on subsets defined by defects in homologous recombination repair, immune cell infiltration, or programmed death ligand receptor 1 expression, an over-active phosphoinositide-3 kinase pathway, or expression of androgen receptors. Though not specific to TNBC, the novel cell surface antigen trophoblast antigen 2 has also been identified and successfully targeted. This work has led to Food and Drug Administration approvals for small molecule poly-ADP-ribosyl polymerase inhibitors in patients with deleterious germline mutations in BRCA1 or BRCA2, the combination of nab-paclitaxel with immune checkpoint inhibitor antibodies in the first-line metastatic setting for programmed death ligand receptor 1+ TNBC, and use of the antibody-drug conjugate sacituzumab govitecan in the later-line metastatic setting. SUMMARY Identification of targetable oncogenic drivers in TNBC is an area of intense cancer biology research, hopefully translating to new therapies and improved outcomes.
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Affiliation(s)
- Kelly E McCann
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Grieb ZA, Ross AP, McCann KE, Lee S, Welch M, Gomez MG, Norvelle A, Michopoulos V, Huhman KL, Albers HE. Sex-dependent effects of social status on the regulation of arginine-vasopressin (AVP) V1a, oxytocin (OT), and serotonin (5-HT) 1A receptor binding and aggression in Syrian hamsters (Mesocricetus auratus). Horm Behav 2021; 127:104878. [PMID: 33148500 PMCID: PMC8889570 DOI: 10.1016/j.yhbeh.2020.104878] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/15/2020] [Accepted: 10/13/2020] [Indexed: 12/13/2022]
Abstract
Dominance status in hamsters is driven by interactions between arginine-vasopressin V1a, oxytocin (OT), and serotonin 1A (5-HT1A) receptors. Activation of V1a and OT receptors in the anterior hypothalamus (AH) increases aggression in males, while decreasing aggression in females. In contrast, activation of 5-HT1A receptors in the AH decreases aggression in males and increases aggression in females. The mechanism underlying these differences is not known. The purpose of this study was to determine if dominance status and sex interact to regulate V1a, OT, and 5-HT1A receptor binding. Same-sex hamsters (N = 47) were paired 12 times across six days in five min sessions. Brains from paired and unpaired (non-social control) hamsters were collected immediately after the last interaction and processed for receptor binding using autoradiography. Differences in V1a, OT, and 5-HT1A receptor binding densities were observed in several brain regions as a function of social status and sex. For example, in the AH, there was an interaction between sex and social status, such that V1a binding in subordinate males was lower than in subordinate females and V1a receptor density in dominant males was higher than in dominant females. There was also an interaction in 5-HT1A receptor binding, such that social pairing increased 5-HT1A binding in the AH of males but decreased 5-HT1A binding in females compared with unpaired controls. These results indicate that dominance status and sex play important roles in shaping the binding profiles of key receptor subtypes across the neural circuitry that regulates social behavior.
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Affiliation(s)
- Z A Grieb
- Neuroscience Institute, Georgia State University, Center for Behavioral Neuroscience, Atlanta, GA, United State of America.
| | - A P Ross
- Neuroscience Institute, Georgia State University, Center for Behavioral Neuroscience, Atlanta, GA, United State of America
| | - K E McCann
- Neuroscience Institute, Georgia State University, Center for Behavioral Neuroscience, Atlanta, GA, United State of America
| | - S Lee
- Neuroscience Institute, Georgia State University, Center for Behavioral Neuroscience, Atlanta, GA, United State of America
| | - M Welch
- Neuroscience Institute, Georgia State University, Center for Behavioral Neuroscience, Atlanta, GA, United State of America
| | - M G Gomez
- Neuroscience Institute, Georgia State University, Center for Behavioral Neuroscience, Atlanta, GA, United State of America
| | - A Norvelle
- Neuroscience Institute, Georgia State University, Center for Behavioral Neuroscience, Atlanta, GA, United State of America
| | - V Michopoulos
- Yerkes National Primate Research Center, Atlanta, GA, United States of America; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - K L Huhman
- Neuroscience Institute, Georgia State University, Center for Behavioral Neuroscience, Atlanta, GA, United State of America
| | - H E Albers
- Neuroscience Institute, Georgia State University, Center for Behavioral Neuroscience, Atlanta, GA, United State of America
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Abstract
While the outcomes for patients diagnosed with hormone receptor positive (HR+) and/or human epidermal growth factor receptor 2-positive (HER2+) breast cancers have continued to improve with the development of targeted therapies, the same cannot be said yet for those affected with triple-negative breast cancer (TNBC). Currently, the mainstay of treatment for the 10-15% of patients diagnosed with TNBC remains cytotoxic chemotherapy, but it is hoped that through an enhanced characterization of TNBC biology, this disease will be molecularly delineated into subgroups with targetable oncogenic drivers. This review will focus on recent therapeutic innovations for TNBC, including poly-ADP-ribosyl polymerase (PARP) inhibitors, phosphoinositide 3-kinase (PI3K) pathway inhibitors, immune checkpoint inhibitors, and cyclin-dependent kinase (CDK) inhibitors.
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Affiliation(s)
- Kelly E McCann
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 2336 Santa Monica, Suite 304, Santa Monica, Los Angeles, CA, 90404, USA.
| | - Sara A Hurvitz
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 2336 Santa Monica, Suite 304, Santa Monica, Los Angeles, CA, 90404, USA
| | - Nicholas McAndrew
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 2336 Santa Monica, Suite 304, Santa Monica, Los Angeles, CA, 90404, USA
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10
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Abstract
Poly-ADP-ribosyl polymerase (PARP) enzymes PARP-1 and PARP-2 recognize DNA damage and set off a cascade of cellular mechanisms required for multiple types of DNA damage repair. PARP inhibitors are small molecule mimetics of nicotinamide which bind to PARP’s catalytic domain to inhibit poly-ADP-ribosylation (PARylation) of target proteins, including PARP-1 itself. PARP inhibitors olaparib, veliparib, talazoparib, niraparib and rucaparib have predominantly been studied in women with breast or ovarian cancers associated with deleterious germline mutations in BRCA1 and BRCA2 (gBRCA1/2+). The BRCA1 and BRCA2 proteins are involved in DNA repair by homologous recombination. This review will focus on talazoparib, a PARP inhibitor approved by the US FDA for the treatment of metastatic gBRCA1/2+ breast cancers in October 2018.
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Affiliation(s)
- Kelly E McCann
- Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA 90095, USA
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McCann KE, Hurvitz SA. Advances in the use of PARP inhibitor therapy for breast cancer. Drugs Context 2018; 7:212540. [PMID: 30116283 PMCID: PMC6089618 DOI: 10.7573/dic.212540] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/05/2018] [Accepted: 07/09/2018] [Indexed: 12/30/2022] Open
Abstract
Poly-ADP-ribose polymerase 1 (PARP-1) and PARP-2 are DNA damage sensors that are most active during S-phase of the cell cycle and that have wider-reaching roles in DNA repair than originally described. BRCA1 and BRCA2 (Breast Cancer) proteins are involved in homologous recombination repair (HRR), which requires a homologous chromosome or sister chromatid as a template to faithfully repair DNA double-strand breaks. The small-molecule NAD+ mimetics, olaparib, niraparib, rucaparib, veliparib, and talazoparib, inhibit the catalytic activity of PARP-1 and PARP-2 and are currently being studied in later-stage clinical trials. PARP inhibitor clinical trials have predominantly focused on patients with breast and ovarian cancer with deleterious germline BRCA1 and BRCA2 mutations (gBRCA1/2+) but are now expanding to include cancers with known, suspected, or more-likely-than-not defects in homologous recombination repair. In ovarian cancer, this group also includes women whose cancers are responsive to platinum therapy. Olaparib was FDA-approved in January 2018 for the treatment of gBRCA1/2+ metastatic breast cancers. gBRCA1+ predisposes women to develop triple-negative breast cancers, while women with gBRCA2+ tend to develop hormone-receptor-positive, human epidermal growth factor receptor 2 negative breast cancers. Although PARP inhibitor monotherapy strategies seem most effective in cancers with homologous recombination repair defects, combination strategies may allow expansion into a wider range of cancers. By interfering with DNA repair, PARP inhibitors essentially sensitize cells to DNA-damaging chemotherapies and radiation therapy. Certainly, one could also consider expanding the utility of PARP inhibitors beyond gBRCA1/2+ cancers by causing DNA damage with cytotoxic agents in the presence of a DNA repair inhibitor. Unfortunately, in numerous phase I clinical trials utilizing a combination of cytotoxic chemotherapy at standard doses with dose-escalation of PARP inhibitors, there has generally been failure to reach monotherapy dosages of PARP inhibitors due to myelosuppressive toxicities. Strategies utilizing angiogenesis inhibitors and immune checkpoint inhibitors are generally not hindered by additive toxicities, though the utility of combining PARP inhibitors with treatments that have not been particularly effective in breast cancers somewhat tempers enthusiasm. Finally, there are combination strategies that may serve to mitigate resistance to PARP inhibitors, namely, upregulation of the intracellular PhosphoInositide-3-kinase, AK thymoma (protein kinase B), mechanistic target of rapamycin (PI3K-AKT-mTOR) pathway, or perhaps are more simply meant to interfere with a cell growth pathway heavily implicated in breast cancers while administering relatively well-tolerated PARP inhibitor therapy.
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Affiliation(s)
- Kelly E McCann
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Sara A Hurvitz
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
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12
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Nakasone ES, Hurvitz SA, McCann KE. Harnessing the immune system in the battle against breast cancer. Drugs Context 2018; 7:212520. [PMID: 29456568 PMCID: PMC5810622 DOI: 10.7573/dic.212520] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 12/14/2022] Open
Abstract
Breast cancer is the most prevalent malignancy in women and the second most common cause of cancer-related death worldwide. Despite major innovations in early detection and advanced therapeutics, up to 30% of women with node-negative breast cancer and 70% of women with node-positive breast cancer will develop recurrence. The recognition that breast tumors are infiltrated by a complex array of immune cells that influence their development, progression, and metastasis, as well as their responsiveness to systemic therapies has sparked major interest in the development of immunotherapies. In fact, not only the native host immune system can be altered to promote potent antitumor response, but also its components can be manipulated to generate effective therapeutic strategies. We present here a review of the major approaches to immunotherapy in breast cancers, both successes and failures, as well as new therapies on the horizon.
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Affiliation(s)
- Elizabeth S Nakasone
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Sara A Hurvitz
- Division of Hematology/Oncology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kelly E McCann
- Division of Hematology/Oncology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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13
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Venteicher AS, Abreu EB, Meng Z, McCann KE, Terns RM, Veenstra TD, Terns MP, Artandi SE. A human telomerase holoenzyme protein required for Cajal body localization and telomere synthesis. Science 2009; 323:644-8. [PMID: 19179534 DOI: 10.1126/science.1165357] [Citation(s) in RCA: 389] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Telomerase is a ribonucleoprotein (RNP) complex that synthesizes telomere repeats in tissue progenitor cells and cancer cells. Active human telomerase consists of at least three principal subunits, including the telomerase reverse transcriptase, the telomerase RNA (TERC), and dyskerin. Here, we identify a holoenzyme subunit, TCAB1 (telomerase Cajal body protein 1), that is notably enriched in Cajal bodies, nuclear sites of RNP processing that are important for telomerase function. TCAB1 associates with active telomerase enzyme, established telomerase components, and small Cajal body RNAs that are involved in modifying splicing RNAs. Depletion of TCAB1 by using RNA interference prevents TERC from associating with Cajal bodies, disrupts telomerase-telomere association, and abrogates telomere synthesis by telomerase. Thus, TCAB1 controls telomerase trafficking and is required for telomere synthesis in human cancer cells.
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Affiliation(s)
- Andrew S Venteicher
- Department of Medicine, Stanford School of Medicine, Stanford, CA 94305, USA
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Song S, McCann KE, Brown JM. Radiosensitization of yeast cells by inhibition of histone h4 acetylation. Radiat Res 2008; 170:618-627. [PMID: 18959465 DOI: 10.1667/rr1420.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Accepted: 07/22/2008] [Indexed: 01/25/2023]
Abstract
Deletion of genes for proteins involved in histone H4 acetylation produces sensitivity to DNA-damaging agents in both Saccharomyces cerevisiae and mammalian cells. In the present studies, we show that treating wild-type yeast cells with histone acetyl transferase (HAT) inhibitors, which are chemicals that cause a global decrease in histone H4 acetylation, sensitizes the cells to ionizing radiation. Using HAT inhibitors, we have placed histone H4 acetylation into the RAD51-mediated homologous recombination repair pathway. We further show that yeast cells with functionally defective HAT proteins have normal phospho-H2A (gamma-H2A) induction after irradiation but a reduced rate of loss of gamma-H2A. This argues that HAT-defective cells are able to detect DNA double-strand breaks normally but have a defect in the repair of these lesions. We also show that cells treated with HAT inhibitors have intact G1 and G2 checkpoints after exposure to ionizing radiation, suggesting that G1 and G2 checkpoint activation is independent of histone H4 acetylation.
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Affiliation(s)
- Suisui Song
- Department of Radiation Oncology, Division of Radiation and Cancer Biology, Stanford University of School of Medicine, Stanford, California
| | - Kelly E McCann
- Department of Radiation Oncology, Division of Radiation and Cancer Biology, Stanford University of School of Medicine, Stanford, California
| | - J Martin Brown
- Department of Radiation Oncology, Division of Radiation and Cancer Biology, Stanford University of School of Medicine, Stanford, California
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15
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Brown JA, Sherlock G, Myers CL, Burrows NM, Deng C, Wu HI, McCann KE, Troyanskaya OG, Brown JM. Global analysis of gene function in yeast by quantitative phenotypic profiling. Mol Syst Biol 2006; 2:2006.0001. [PMID: 16738548 PMCID: PMC1681475 DOI: 10.1038/msb4100043] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2005] [Accepted: 12/01/2005] [Indexed: 11/09/2022] Open
Abstract
We present a method for the global analysis of the function of genes in budding yeast based on hierarchical clustering of the quantitative sensitivity profiles of the 4756 strains with individual homozygous deletion of nonessential genes to a broad range of cytotoxic or cytostatic agents. This method is superior to other global methods of identifying the function of genes involved in the various DNA repair and damage checkpoint pathways as well as other interrogated functions. Analysis of the phenotypic profiles of the 51 diverse treatments places a total of 860 genes of unknown function in clusters with genes of known function. We demonstrate that this can not only identify the function of unknown genes but can also suggest the mechanism of action of the agents used. This method will be useful when used alone and in conjunction with other global approaches to identify gene function in yeast.
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Affiliation(s)
- James A Brown
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305-5152, USA.
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Matsuda SP, Darr LB, Hart EA, Herrera JB, McCann KE, Meyer MM, Pang J, Schepmann HG. Steric bulk at cycloartenol synthase position 481 influences cyclization and deprotonation. Org Lett 2000; 2:2261-3. [PMID: 10930258 DOI: 10.1021/ol006018w] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cycloartenol synthase converts oxidosqualene to the pentacyclic sterol precursor cycloartenol. An Arabidopsis thaliana cycloartenol synthase Ile481Val mutant was previously shown to produce lanosterol and parkeol in addition to its native product cycloartenol. Experiments are described here to construct Phe, Leu, Ala, and Gly mutants at position 481 and to determine their cyclization product profiles. The Phe mutant was inactive, and the Leu mutant produced cycloartenol and parkeol. The Ala and Gly mutants formed lanosterol, cycloartenol, parkeol, achilleol A, and camelliol C. Monocycles comprise most of the Gly mutant product, showing that an alternate cyclization route can be made the major pathway by a single nonpolar mutation.
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Affiliation(s)
- S P Matsuda
- Department of Chemistry and Department of Biochemistry and Cell Biology, Rice University, 6100 South Main Street, Houston, Texas 77005, USA.
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McCann MC, McCann KE. Familial dysautonomia: some aspects of treatment for the paediatric dental practitioner. Dent Pract Dent Rec 1970; 20:345-6. [PMID: 4248260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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